Neuromuscular blockers are the most popular products/ procedures in plastic surgery. Botox has become a household name over the last few years but what the product is good for, competitors and how they work is still confusing to many. I still get questions like “what’s the difference between Botox and Restylane” Dr Jason Pozner in this 101 video explains neuromuscular blockers in simple terms.
What is a neuromuscular blocker?
Botox is in a class of drugs we call “neuromuscular blockers” because they basically block the nerve signals to specific muscles. Other neuromuscular blockers we use are Dysport and soon to be approved Xeomin. There are a few other neuromuscular blockers on the way from other companies we may hear about soon.
All of the neuromuscular blockers are derived from a bacterial toxin (Clostridia neurotoxin) and differ a bit in their chemical makeup and some properties such as duration, spread etc.
The mechanism of action is identical for all of the Clostridia derived toxins like Botox, Dysport and Xeomin – they all block acetylcholine release from specific nerve endings – in basic terms they block the signal from the nerve to specific muscles. This causes the muscle not to work for a period of time.
Are the neuromuscular toxins safe?
The first question anyone asks is – “is it safe”. The overwhelming answer is yes. These products have been in clinical use for many years now with millions of applications per year. The side effects are minimal. However the FDA has a “black box” warning on the box that problems may arise due to distant spread. For cosmetic use the risk of spread is almost none. The problems arose for higher doses used to treat spasticity (especially in children).
The next question is “where do u use the blockers”. The FDA has approved Botox and Dysport for the glabella – the area between the eyebrows. Other areas we use them for – (off label) are the forehead, crows feet, around the mouth, neck bands. The duration of effect is usually 3-4 months and the blockers typically take a few days to take effect.
So what’s the difference between Restylane and Botox – Botox we know now is a nueuromuscular blocker used to treat lines in the face and approved for the lines in the glablella. Restylane is a filler made from hyaluronic acid that is used to volumize the face and FDA approved for nasolabial creases. Other fillers are Juvederm, Radiesse, Perlane etc. You can use the neuromuscular blockers and fillers together – the blocker relaxes the muscle and the filler fills the lines.
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